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Case Presentation: A 34-year-old woman presented to the emergency department with bilateral lower extremity edema and shortness of breath. She had been seen by her primary care provider. Lab work and a follow-up with endocrinology had been unrevealing. Using point-of-care ultrasound we identified a cystic mass in the right upper quadrant prompting further imaging.Discussion: Abdominal and pelvic computed tomography confirmed a mass in the right posterior liver, which was later identified as an adrenocortical carcinoma. Ultrasound is an important diagnostic tool in the setting of lower extremity edema and can be used to assess for heart failure, liver failure, obstructive nephropathy, venous thrombosis, and soft tissue infection. In this case, ultrasound helped expedite the diagnosis and treatment of a rare malignancy.

A family of simple fixed-lag frequency smoothing algorithms which provide good estimates of both frequency and frequency rate-of-change is reported. The smoothers were developed from a fixed-gain AlphaBeta tracker by replacing the recursive derivative estimator with a finite-impulse-response (FIR) differentiator. Simulation results are presented which show that the smoothing algorithms provide frequency estimates with a similar variance to those produced by the Alpha-Beta filter but with greatly improved frequency-rate estimates. The smoothing algorithms and the AlphaBeta filter are also compared on the basis of the bias and delay introduced in the frequency-rate estimates. Although the results presented here are for frequency estimation, the smoothing algorithms can be used in any single-input tracking application where some lag in the estimates is allowable.

Patients with a known cancer diagnosis are frequent visitors to general emergency departments (ED) Since MD Anderson Cancer Center is a dedicated oncologic hospital, new patients present with symptoms suspected to be attributable to a yet unconfirmed cancer diagnosis. The aim was to examine and characterize the oncologic ED presentation of new patients with a suspicion of cancer. Our institutional database was quired for all ED visits for subjects aged 18 and older with no prior cancer diagnosis (using tumor registry and billing database) between 11/1/2020 and 01/01/2022. Chart review was conducted to confirm the absence of previous cancer diagnosis in the identified subjects and to verify they received follow-up in our institution. Demographics, ED presentation and clinical data were collected. Descriptive statistics and Chi-Square test of independence were used to analyze, compare and report the presentation and the outcomes of final eligible patients. During the study period, of the 2727 subjects identified, 358 met the final eligibility criteria. The median age was 57 years (interquartile range: 45-66 years). The majority were male (51.1%), White or Caucasian race (57.0%) and not Hispanic or Latino ethnicity (74.0%). Almost all the patients (99.2%) were presented as emergent or urgent acuity level (i.e., Emergency Severity Index levels 2 or 3 respectively). The most frequent presenting complaint(s) were: Abnormal laboratory results (16.8%); Hypertension (9.8%); infection and/or suspected sepsis (7.5%); nausea/vomiting (7.3%); fatigue (7.0%); shortness of breath (6.7%) or headache (5.9%). Most of the patients were admitted either to the hospital (59.2%) or the observation unit (18.2%). Of the 212 admitted patients, 35 (16.5%) died within one year of the ED presentation, which was significantly (P=0.003) higher than the 5.5% one-year mortality rate for the patients who were discharged or placed in the observation unit. Most patients presenting to an oncologic emergency with unconfirmed suspicion of cancer require hospitalization. The admitted group have higher mortality for reasons that need further elucidation. Further research is also needed to understand why the fairly large segment that do not require hospitalization seek care in the ED setting. [ABSTRACT FROM AUTHOR]

On examination, the patient was found to have a 9 × 5 cm irregular, atrophic, pink-purple plaque with ill-defined borders and multiple satellite lesions on her right lower back (Fig.). Histologic examination revealed interstitial spindled cells in the mid-dermis that encircled thickened collagen bundles (Fig.). GLO:DIF/01oct19:ijd14230-fig-0002.jpg PHOTO (COLOR): Low-power magnification demonstrates a proliferation of spindled cells within the dermis with peripheral collagen trapping by the spindled cells (H&E, ×40) gl. [Extracted from the article]

Abstract: The Manyingee ore body is a roll-front U ore body located at depth in the Cretaceous sandstone sediments of a Proterozoic palaeo valley. It is located in a confined aquifer. The aquifer is recharged 4 km upstream by the Ashburton River. Groundwater samples were collected at and up to 4.7 km downstream of the ore body. The ground water 234U/238U activity ratios (AR) were elevated to 1.86 in the vicinity of the ore body and then declined to 1.06 over the 4.7 km transect. The elevated 234U/238U ARs are attributed to selective leaching of 234U sites by oxidising waters, with α recoil as a necessary precursor to produce activated 234U sites. Direct ejection into another phase following α recoil is considered to be a minor contributor to 234U –238U disequilibrium in this environment. The profile is considered to be typical of the 234U/238U AR profile at and down gradient of the redox front of a U ore body. [Copyright &y& Elsevier]

Abstract: The Ranger 3 ore body is an early Proterozoic U ore body in the Alligator Rivers U province, Northern Territory, Australia. It has surface expression with a redox front located between 30 and 50 m below the surface. The ground water U concentration and 234U/238U AR signature in the top 10 m of the weathered zone are reported for 357 samples collected over 4 wet seasons, at 5 depths, along a transect in-line with the hydraulic gradient and along the centre line of the ore body and its associated dispersion halo. The results show that the weathered zone displays a general U isotope feature for this type of ore body with the 234U/238U AR for the ground water and amorphous phase of the solid matrix being less than 1. The ground water 234U/238U AR is independent of the annual monsoonal climate and depth within the range surface to 10 m. In the vicinity of the U ore body the ground water 234U/238U AR is 0.75 and is very similar to the 234U/238U AR of the amorphous phase of the solid (0.76). The 234U/238U ARs of the amorphous phase and ground water rise and separate to values of 0.88 and 1.02 at the end of the transect. The rise and separation in 234U/238U AR are interpreted as evidence that the source of the U in the ground water is from the water-soluble sub-phase of the amorphous phase and that the ground water flow is too fast to allow the processes occurring across the solid–water interface to reach chemical equilibrium. The data set is a robust characterisation of the coarse and fine detail of the 234U/238U AR signature in the weathered zone of U ore bodies. [Copyright &y& Elsevier]

The article focuses on brownfields in New York City and the three ways to remediate them. PlaNYC is Mayor Michael R. Bloomberg's sustainability plan for New York City and contains proposals related to housing, open space, brownfields, water quality and reliability and transportation, among others. Ways to clean a brownfield in New York City include supervision of the clean up by the Department of Environmental Conservation (DEC), overseeing the cleanup by the Department of Environmental Protection (DEP), and for a developer to oversee its own cleanup.

Despite the low-cost, high-efficiency, radical form factor promise of many thin-film photovoltaic technologies, scaling these materials to large-volume production has presented a wide array of challenges. Because of the recent polysilicon shortage, an incredible amount of resources have been focused on this goal and many thin-film alternatives are now available. One of the most intriguing of these materials, copper indium gallium diselenide (CIGS), has great potential to reset the thin-film market and make new applications cost effective and viable. CIGS technology is differentiated from competing PV materials by a combination of factors. The manufacturing cost of thin-film cells can be very inexpensive since they require few raw materials and can be made with an efficient, scalable roll-to-roll process. GIGS has been established as the most efficient thin-film technology in converting sunlight into electricity. A flexible substrate will ultimately enable energy and building-integrated applications beyond the capability of rigid, heavier PV products. [ABSTRACT FROM AUTHOR]

INTRODUCTION:Historically, many Health Technology Assessment (HTA) bodies were developed with a focus on addressing rapidly rising drug costs and the unique need to evaluate each drug as a de novo entity. The degree to which the unique needs for evaluating technologies vis a vis drugs are reflected in distinct HTA methods and activity is to date understudied.METHODS:We examined HTA's reviews of two technologies: WATCHMAN™, a device to reduce the risk of stroke in certain patients and Alair™, a procedure-based treatment for severe asthma. Both technologies have been extensively reviewed by HTA bodies and payers in many countries. These HTA reviews are compared to a convenience sample of these HTA's bodies reviews of drugs and qualitative differentiators between these two categories explored.RESULTS:The differences and similarities (for example, in rigor and necessity of evidence) between US Section 510(k) clearances, US premarket approval (PMA), and US new drug application (NDA) regulatory pathways have not been clearly understood by HTA or reflected in their methodologies employed. Additionally, emergent methodologies such as Bayesian statistical analyses may encounter challenges within technologies reviews. HTA bodies may not be cognizant of development timelines or the timelines of comparators. Finally, HTA bodies may overestimate device adoption rates.CONCLUSIONS:The differences in evidence requirements for regulatory approval between US 510(k), US PMA, and US NDA pathways have not been reflected in different methodological approaches within HTA bodies reviews. Opportunities and novel methods are needed for HTA bodies to derive imputed comparisons between technologies that may have inherently incongruent timelines. Finally, HTA bodies could benefit from methods to more accurately estimate projected adoption curves. Challenges exist using frameworks, paradigms, and methodologies initially established for, and commonly used for, pharmaceuticals on device evaluations; leaders of HTA methods can improve the situation by providing guidance and recommendations for more appropriate HTA methods to evaluate devices. [ABSTRACT FROM PUBLISHER]